In retail, hospital, long-term-care and mail order medication dispensing, a large number of different prescription orders made up of one or more prescriptions for single-dose medications, such as tablets, must be fulfilled. “Fulfillment” as used herein refers to the process of handling and executing customer orders. For pharmacies, the customer is most typically a patient, that is someone for whom the medication is intended. However, pharmacy customers are not limited to patients and may include persons who seek fulfillment of orders for non-prescription tablets such as nutriceuticals, vitamins and supplements. The term “tablets” as used herein should be understood as being generic to pills, tablets, capsules, caplets, gel-filled capsules (gel-caps), liquid-filled capsules, particle-filled capsules and any other solid-dose medication type including prescription and non-prescription medications and products. Tablets, as used herein, are a type of discrete object capable of being counted automatically.
For prescriptions requiring small quantities of a medication, the prescription is often filled by hand; that is, a bulk storage container containing the prescription medication is removed from a shelf and opened. A quantity of the medication is poured into a tray and the medication tablets are counted by a pharmacist and then dispensed into a patient prescription container, such as a bottle or vial. The remainder of the medication in the tray is returned to the bulk container, the bulk container is closed and then replaced on a pharmacy storage shelf.
Larger quantity prescriptions are often filled with the aid of a counting apparatus intended to more rapidly count different quantities of different tablets. For example, a prescription for ninety (90) tablets of 10 mg Claritin® may need to be filled after a prescription for sixty (60) tablets of 400 mg Motrin®. Counting apparatus can be used to expedite the process of filling prescriptions calling for larger quantities of tablets that would be time-consuming and laborious to count manually.
One type of counting apparatus effective for rapid counting of different quantities of different tablets is known as a pour-through counter. With a pour-through tablet counter, the pharmacist pours tablets from a bulk container directly into a funnel. The tablets are counted when they drop past a tablet-counting sensor. The tablets fall past the tablet-counting sensor and into a removable tray, or are directed into a container for the patient prescription order. The pharmacist pours the tablets until a digital readout of the counter apparatus displays the required number of tablets, and then stops. As such, there is usually no excess. However, should an extra tablet or so fall into the funnel, the readout clearly indicates the extra number, and the excess can easily be removed by the pharmacist and returned to the bulk storage container.
Pour-through tablet counters are quite effective at providing an accurate count of the tablets required by a prescription. However, a drawback of such tablet counters is that the counters do not manage a broader range of pharmacy workflow tasks.
As an alternative to manual pouring of tablets into the tablet counter, an automatic-type tablet feeder may be provided to feed tablets to the counter. Examples of automatic-type feeders are cassette-type or vibratory-bowl-type feeders described in U.S. Pat. Nos. 6,497,339 and 6,659,304 or a mechanical feeder such as the rotating assembly described in U.S. Pat. No. 7,219,703.
A cassette is a container that holds bulk-form tablets and objects. Each cassette is pre-loaded, or filled, by pharmacy personnel with a bulk quantity of a tablet-form medication or other product. Tablets are fed from the cassette.
There are many potential advantages to the use of cassettes by a pharmacy. For example, cassettes are efficient and reduce the time required to fulfill a prescription. Cassettes can hold a large amount of tablets, thereby reducing the need to retrieve and return to storage a container holding the medication and the need to manually pour tablets from the manufacturer's container. Cassette usage permits the pharmacist to perform other value-added tasks while tablets are automatically fed from the cassette. Cassettes for more frequently-used tablets can be stored at a convenient location proximate the tablet counter. Cassettes can be used to dispense tablets at a rapid rate, thereby reducing the time required to fulfill a prescription.
Certain cassette types are calibrated or designed for a specific size and shape tablet. U.S. Pat. No. 7,395,946 describes tablet cassettes which may be calibrated. Calibration involves adjustment of the cassette so that the cassette will dispense tablets in a singulated manner, that is one tablet after the other. Calibration can involve adjustment of the size of the cassette opening through which the tablet exits the cassette, for example, by providing a smaller opening for small-size tablets or a larger opening for large-size tablets. As an alternative to calibration, the cassette may be manufactured with a single-size opening for a particular tablet size or shape.
Problems can arise if the cassette is not calibrated properly or if the cassette is incorrectly sized for the type of tablet to be dispensed from the cassette. More specifically, use of an incorrectly calibrated or sized cassette can result in plural tablets being fed simultaneously from the cassette. The tablets are fed from the cassette and pass a sensor. Detection of the tablets by the sensor is used to make a tablet count.
The process of counting from the cassette is not completely accurate. If tablets fed from the cassette pass the sensor simultaneously, a single count may be registered even though plural tablets are dispensed. Missed tablet counts result in prescription order fulfillment errors and can amount to “giving away” costly tablet-form medication. Many dispensing cycles may be performed before the error is detected by pharmacy personnel. Small tablets or tablet fragments may not be detected by the sensor. Tablet fragments may be detected as a complete tablet, thereby failing to completely fulfill the prescription.
Because pharmacy-personnel time is valuable, obtaining an accurate count in the least amount of time is advantageous. Vibratory-type dispensers which feed tablets from a cassette as described in U.S. Pat. Nos. 6,497,339 and 6,659,304 are potentially excellent for their intended purpose, but tend to require a relatively greater amount of time to automatically dispense the required tablets or other discrete objects. This is because the vibratory action required to singulate the discrete objects from the vibrating cassette tends to be somewhat slow. Moreover, tablet counting for vibratory systems is performed only by the discrete object counter. Additional time is required for the tablets to exit the cassette, fall past the object counter to make a count and for the appropriate feedback to be provided to the vibration system which controls feeding to the objects to the discrete object counter.
The time required to count a specified quantity of tablets from a vibratory dispenser system can be excessive. For example, a pharmacy may be required to perform repetitive counting and packaging operations for unit-of-use containers. Unit-of-use containers are frequently used to hold pre-packaged 30, 60 or 90-day tablet quantities. The pre-packaged unit-of-use containers may be stocked at a pharmacy “speed-shelf” permitting rapid retrieval by pharmacy personnel. As can be appreciated, rapid, accurate counting is desirable to minimize the time required for performance of these repetitive counting operations.
Workflow in a retail, hospital or mail order pharmacy is typically managed by a computer-driven system known generally as a pharmacy management system, or PMS. For each prescription order, information required to fulfill each prescription of the prescription order is input to the PMS, typically by a pharmacy technician. The PMS processes each prescription of the prescription order to determine that the pharmacy can fulfill the prescription order.
For prescriptions requiring manual tablet counting, the PMS generates prescription order paperwork known generally by the term “label.” The paperwork includes all information necessary for fulfillment of the prescription and typically includes an adhesive-backed label for application to each container for each prescription within the prescription order. The paperwork is typically printed by an automatic printer located within the pharmacy. Each prescription of a prescription order is simply filled in the order in which the paperwork is generated by the PMS. The pharmacist or pharmacy technician follows the information on the paperwork and can use the tablet counter to count out the desired quantity of tablets as previously described. The fulfilled prescription order is provided to the patient in one or more containers once all medications required by the prescription order have been verified and payment has been made or arranged.
A drawback of such a system is that the pharmacist operating the tablet counter does not have the ability to manage pharmacy workflow. The pharmacist simply fulfills the prescription orders in the order in which they are provided by the PMS. There may be a large number of prescription orders awaiting fulfillment at any given time. By way of example only, in certain circumstances it may be desirable to fulfill patient prescription orders out of turn. One such circumstance could involve a need to fulfill a prescription order for a patient who is waiting to pick up medications before an earlier processed prescription order for a patient who will not pick up the prescription order until the following day.
By way of further example, a patient might have a question of the pharmacist operating the tablet counter. The pharmacist may be unable to respond to the question because the printed label paperwork might not yet be available from the PMS.
Presently, the pharmacist would be required to access the PMS to perform any modification of the pharmacy workflow or obtain detailed information about the patient's prescription order with which to answer the patient's questions. Utilization of the PMS for these or other purposes may be inconvenient or require more time to complete than if the workflow management process could simply be controlled by means of the tablet counter.
It would be an advance in the art to provide an improved pharmacy workflow management system which would facilitate tablet counting, would enable improved control of pharmacy workflow, and which would contribute to an improvement in the overall quality of patient care. And, it would be an advance in the art to provide an improved tablet counter which could be used with the pharmacy workflow management system or as a stand-alone apparatus and which would enable use of the tablet counter with medication-specific cassettes, also improving the quality of patient care.